title: Risk stratification of metastatic recurrence in invasive upper urinary tract carcinoma after radical nephroureterectomy without lymphadenectomy.
abstract: OBJECTIVE
  To assess the risk factors of metastasis relapse in pT2-3 upper tract urothelial carcinomas (UTUCs) treated by radical nephroureterectomy (RNU) without lymphadenectomy (LN).
  
  
  METHODS
  A multicentric retrospective study was performed for pT2-3 pNx UTUCs treated by RNU between 1995 and 2010. The following criteria were retrieved: age, gender, American Society of Anaesthesiologists physical status, surgical approach, preoperative hydronephrosis, stage, grade, tumor location, surgical margin, lymphovascular invasion (LVI) status and outcomes. Metastasis-free survival (MFS) was measured by Kaplan-Meier method with the log-rank test.
  
  
  RESULTS
  Overall, 151 patients were included. The median follow-up was 18.5 months (IQR 9.5-37.9). The 2- and 5-year MFS were 69 % ± 4.5 and 54.1 % ± 5.8, respectively. In univariate analysis, ureteral location, pT3 stage, positive LVI status and positive surgical margin were significantly associated with worse MFS (p = 0.03; 0.02; 0.01 and 0.006, respectively). In the multivariate analysis of ureteral location and pT3 stage were independent prognostic factors (p = 0.03 and 0.03, respectively). Based on the results of the univariate analysis, we proposed a risk model predicting MFS, which classifies patients into 3 categories with different overall survival (p < 0.001).
  
  
  CONCLUSIONS
  In view of our data, tumor location, T stage, LVI and surgical margin status are mandatory to predict survival in case of RN without LN. Contingent upon external validation, our risk model based on these variables could be useful to provide relevant information concerning metastasis relapse probability and necessity of close follow-up for these patients.
authors.affiliation: Department of Urology, Claude Huriez University Hospital, CHRU Lille, Lille, France, pierre_colin@msn.com.
authors.forename: Pierre
authors.initials: P
authors.lastname: Colin
authors.forename: Tarek P
authors.initials: TP
authors.lastname: Ghoneim
authors.forename: Laurent
authors.initials: L
authors.lastname: Nison
authors.forename: Thomas
authors.initials: T
authors.lastname: Seisen
authors.forename: Eric
authors.initials: E
authors.lastname: Lechevallier
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
authors.forename: Adil
authors.initials: A
authors.lastname: Ouzzane
authors.forename: Marc
authors.initials: M
authors.lastname: Zerbib
authors.forename: Jean-Alexandre
authors.initials: JA
authors.lastname: Long
authors.forename: Alain
authors.initials: A
authors.lastname: Ruffion
authors.forename: Sébastien
authors.initials: S
authors.lastname: Crouzet
authors.forename: Olivier
authors.initials: O
authors.lastname: Cussenot
authors.forename: Marie
authors.initials: M
authors.lastname: Audouin
authors.forename: Jacques
authors.initials: J
authors.lastname: Irani
authors.forename: Solène
authors.initials: S
authors.lastname: Gardic
authors.forename: Pascal
authors.initials: P
authors.lastname: Gres
authors.forename: François
authors.initials: F
authors.lastname: Audenet
authors.forename: Mathieu
authors.initials: M
authors.lastname: Roumiguié
authors.forename: Antoine
authors.initials: A
authors.lastname: Valeri
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D007682:Kidney Pelvis / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D014513:Ureter / Q000601:surgery*; D014516:Ureteral Neoplasms / Q000473:pathology / Q000601:surgery*